Intramural hematoma(IMH) and penetrating aortic ulcer have been increasingly recognized as causes of acute aortic pathology in addition to aortic dissection. The presence of the intimal tear and a flap traversing the aortic lumen is considered to be a most reliable differential point of aortic dissection and IMH. Transesophageal echocardiography(TEE) has become a valuable modality for the diagnosis, prognosis and management of acute aortic syndrome with the unique advantages of portability and the ability to obtain high-resolution real time images. Endovascular Stent-graft placement over the primary entry tear may be an alternative to open surgery because it can close the intimal tear, which leads to thrombosis of the false lumen, excluding flow through the intimal tear and redirecting aortic flow exclusively into the true lumen. We report 88 year-old male with aortic dissection in descending thoracic aorta, successfully treated with endovascular Stent-graft implantation, which was mimicking intramural hematoma by its appearance and subclinical intimal tear diagnosed exclusively by TEE against other imaging studies.
Aged, 80 and over ; Aorta, Thoracic* ; Diagnosis ; Hematoma* ; Humans ; Male ; Pathology ; Prognosis ; Thrombosis ; Ulcer

The aortic dissection is an acute aortic syndrome, caused by an intimal tear and subsequent splitting of the media by the pulsatile blood flow. Though there would be differences in the origin of aortic dissection and therapeutic modalities, the intermediate and long-term prognoses are poor. Endovascular Stent-graft implantation is a revolutionary technique in the treatment of aortic dissection. The endovascular stent grafting in aortic dissection is less invasive and feasible method and is an effective tool for closing the entry site and promoting clot formation, reducing the size of the false lumen. Therefore, endovascular Stent-graft implantation makes possible the desirable remodelling of aorta. We report 33 year-old male with aortic dissection in the thoracic aorta, which was treated with endovascular Stent-graft implantation. Over the favorable remodelling, his dissection was healed completely by the endovascular treatment using Stent-graft.
Adult ; Aorta ; Aorta, Thoracic* ; Blood Vessel Prosthesis ; Humans ; Male ; Prognosis

Kawasaki disease is an acute febrile illness frequently developed in infants and children. This disease may involve coronary arteries in 15- 25% of the patients and may progress to coronary aneurysms, ischemic cardiac diseases, and sudden cardiac death. Recently we experienced successful balloon angioplasty followed by coronary stenting in a 15-year old boy with unstable angina and severe coronary arterial occlusive disease secondary to Kawasaki disease. He was diagnosed as unstable angina by 24 hours Holter monitoring, treadmill exercise stress test, echocardiography, and Dipyridamole 99mTc-sestamibi scan. And coronary angiogram revealed severe multiple stenosis and aneurysmal changes due to Kawasaki disease. We successfully performed a percutaneous transluminal coronary angioplasty with stent implantation at left circumflex arterial occlusive lesion.
Adolescent ; Aneurysm ; Angina, Unstable ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Arterial Occlusive Diseases ; Child ; Constriction, Pathologic ; Coronary Aneurysm ; Coronary Stenosis* ; Coronary Vessels* ; Death, Sudden, Cardiac ; Dipyridamole ; Echocardiography ; Electrocardiography, Ambulatory ; Exercise Test ; Heart Diseases ; Humans ; Infant ; Male* ; Mucocutaneous Lymph Node Syndrome* ; Stents* ; Technetium Tc 99m Sestamibi

BACKGROUND: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. MATERIAL AND METHOD: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs (43-70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy (24) and CT scans (7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects (6), refusal (1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. CONCLUSION: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.
Biopsy ; Carcinoma, Non-Small-Cell Lung ; Cause of Death ; Chemoradiotherapy* ; Cisplatin ; Disulfiram ; Drug Therapy ; Esophagitis ; Female ; Fever ; Humans ; Lung Neoplasms ; Male ; Mortality ; Neoplasm Metastasis ; Radiation Pneumonitis ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed

No abstract available.
Renal Insufficiency*

BACKGROUND AND OBJECTIVES: Slow flow or no-reflow during the primary angioplasty is associated with a poor prognosis. The impact of adjuvant balloon inflation on infarct artery flow after successful primary stenting has not yet been studied. Therefore, we investigated the effect of adjuvant balloon inflation on infarct related artery flow after successful stenting in patients with acute myocardial infarction. SUBJECTS AND METHODS: The changes in infarct artery flow before and after adjuvant balloon inflation were assessed in 46 patients with a first episode of acute myocardial infarction (pain duration > 12 hr) who underwent adjuvant balloon inflation after successful primary stenting. Infarct artery flow was evaluated by corrected TIMI frame count (CTFC). RESULTS: After adjuvant balloon inflation, 20 patients (43%) showed a slower flow. The minimal lumen diameter became greater (3.0 > 0.5 mm vs. 3.2 > 0.5 mm, p=0.002) and the residual stenosis lessened (12.2 > 9.6% vs. 6.4 > 8.1%, p<0.001). There was no change in reference vessel diameter. CTFC was significantly increased after adjuvant balloon inflation (21.6 > 11.5 frames vs. 26.9 > 20.5 frames, p=0.005). On multivariate analysis, only pre-adjuvant balloon CTFC was a predictor of a slower flow after adjuvant balloon inflation (odds ratio 1.148, 95% CI:1.014-1.301). CONCLUSION: Adjuvant balloon inflation after successful primary stenting reduced residual stenosis but deteriorated the infarct artery flow. Further studies are required to define the clinical impact of the positive and negative effects of adjuvant balloon inflation.
Angioplasty ; Arteries* ; Constriction, Pathologic ; Coronary Circulation ; Humans ; Inflation, Economic* ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Stents*

BACKGROUND: The early diagnosis of candidemia is critical for the management. The candidemia is known to be associated with 10% of candiduria. But the risk factors in patients with candiduria who are associated with candidemia are not known. We analyzed the risk factors in patients with candiduria who are associated with candidemia. METHODS: We retrospectively reviewed 164 patients with candiduria in Yonsei Medical Center from January 1998 to December 1998. Candiduria patients were divided into two groups. Candiduria patients without candidemia (Group I, 147 patients) and candiduria patients with candidemia (Group II, 17 patients). RESULTS: 1) The mean age of the patients were 57.5 years in group I and 62.5 years in group II. There were no significant differences in the sex ratio between the two groups. 2) Central venous catheter insertion (53%, 100% in group I, II), hypotension (14%, 59% in group I, II), other associated infections (64%, 100% in group I, II), intensive care (41, 76% in group I, II) and fever (46%, 82% in group I, II) were the very significant risk factors in patients with candiduria who were associated with candidemia. 3) Urinary tract procedure (11%, 88% in group I, II), urinary catheter insertion (63%, 94% in group I, II), thrombocytopenia (17%, 41% in group I, II) and DM (8%, 24% in group I, II) were the significant risk factors of candidemia. 4) Candida colony count (cfu/mL) of urine culture was not a significant risk factor. 5) Mortality rate (27%, 59% in group I, II) was significantly high in patients with candidemia. CONCLUSION: Central venous catheter insertion, hypotension, other associated infections, intensive care and fever were the very significant risk factors of candidemia in patients with candiduria.
Candida ; Candidemia* ; Candidiasis ; Central Venous Catheters ; Early Diagnosis ; Fever ; Humans ; Hypotension ; Critical Care ; Mortality ; Retrospective Studies ; Risk Factors* ; Sex Ratio ; Thrombocytopenia ; Urinary Catheters ; Urinary Tract

BACKGROUND: The early diagnosis of candidemia is critical for the management. The candidemia is known to be associated with 10% of candiduria. But the risk factors in patients with candiduria who are associated with candidemia are not known. We analyzed the risk factors in patients with candiduria who are associated with candidemia. METHODS: We retrospectively reviewed 164 patients with candiduria in Yonsei Medical Center from January 1998 to December 1998. Candiduria patients were divided into two groups. Candiduria patients without candidemia (Group I, 147 patients) and candiduria patients with candidemia (Group II, 17 patients). RESULTS: 1) The mean age of the patients were 57.5 years in group I and 62.5 years in group II. There were no significant differences in the sex ratio between the two groups. 2) Central venous catheter insertion (53%, 100% in group I, II), hypotension (14%, 59% in group I, II), other associated infections (64%, 100% in group I, II), intensive care (41, 76% in group I, II) and fever (46%, 82% in group I, II) were the very significant risk factors in patients with candiduria who were associated with candidemia. 3) Urinary tract procedure (11%, 88% in group I, II), urinary catheter insertion (63%, 94% in group I, II), thrombocytopenia (17%, 41% in group I, II) and DM (8%, 24% in group I, II) were the significant risk factors of candidemia. 4) Candida colony count (cfu/mL) of urine culture was not a significant risk factor. 5) Mortality rate (27%, 59% in group I, II) was significantly high in patients with candidemia. CONCLUSION: Central venous catheter insertion, hypotension, other associated infections, intensive care and fever were the very significant risk factors of candidemia in patients with candiduria.
Candida ; Candidemia* ; Candidiasis ; Central Venous Catheters ; Early Diagnosis ; Fever ; Humans ; Hypotension ; Critical Care ; Mortality ; Retrospective Studies ; Risk Factors* ; Sex Ratio ; Thrombocytopenia ; Urinary Catheters ; Urinary Tract

KITENIN (KAI1 C-terminal interacting tetraspanin) promotes invasion and metastasis in mouse colon cancer models. In the present study, we evaluated the effects of KITENIN knockdown by intravenous administration of short hairpin RNAs (shRNAs) in an orthotopic mouse colon cancer model, simulating a primary or adjuvant treatment setting. We established orthotopic models for colon cancer using BALB/c mice and firefly luciferase-expressing CT-26 (CT26/Fluc) cells. Tumor progression and response to therapy were monitored by bioluminescence imaging (BLI). In the primary therapy model, treatment with KITENIN shRNA substantially delayed tumor growth (P = 0.028) and reduced the incidence of hepatic metastasis (P = 0.046). In the adjuvant therapy model, KITENIN shRNA significantly reduced the extent of tumor recurrence (P = 0.044). Mice treated with KITENIN shRNA showed a better survival tendency than the control mice (P = 0.074). Our results suggest that shRNA targeting KITENIN has the potential to be an effective tool for the treatment of colon cancer in both adjuvant and metastatic setting.
Animals ; Carrier Proteins/*genetics/metabolism ; Cell Line, Tumor ; Colonic Neoplasms/genetics/mortality/pathology/*therapy ; Disease Progression ; Liver Neoplasms/prevention & control/*secondary ; Membrane Proteins/*genetics/metabolism ; Mice ; Mice, Inbred BALB C ; Neoplasm Metastasis/*prevention & control ; Neoplasm Recurrence, Local/genetics/*prevention & control ; RNA Interference ; RNA, Small Interfering/*therapeutic use ; Tumor Markers, Biological/genetics

PURPOSE: When the full veneer crown was treated in the tooth with abfraction lesion due to various causes, the prognosis of it may be compromised according to the location of the finish line, but there is few study about the location of its buccal finish line. The purpose of this study was to investigate the effect of location of the finish line of the full veneer crown on stress distribution of the tooth with abfraction lesion. MATERIALS AND METHODS: The two dimensional finite element model was developed to express tooth, surrounding tissue and full veneer crown. The stress distribution under eccentric 144 N occlusal load was analyzed using finite element analysis. The location of finish line was set just at the lower border of the lesion (Group 0), 1 mm (Group 1) and 2 mm (Group 2) below the lower border of the lesion. RESULTS: In the Group 0, von Mises stress was concentrated at the finish line and the apex of the lesion. Also, the stress at the bucal finish line propagated to the lingual side. In the Group 1 and Group 2, stress distribution was similar each other. Stress was concentrated at the apex of lesion, but the stress at the buccal finish line did not propagate to the lingual side. That implied decrease of the possibility of horizontal crown fracture. CONCLUSION: Full veneer crown alleviated the stress concentrated at the apex of the abfraction lesion, when the finish line of full veneer crown was set below the lower border of abfraction lesion.
Crowns* ; Finite Element Analysis ; Prognosis ; Tooth*